Provider Demographics
NPI:1801163621
Name:ARNOLD-ROBLEDO, LISA (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:ARNOLD-ROBLEDO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 WESLEYAN RD
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-2518
Mailing Address - Country:US
Mailing Address - Phone:631-864-3545
Mailing Address - Fax:
Practice Address - Street 1:35 CARMAN RD
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-5651
Practice Address - Country:US
Practice Address - Phone:631-549-5580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009544-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist